World's First Transcontinental Anesthesia

An anonymous reader writes "Medical Daily reports: 'Video conferences may be known for putting people to sleep, but never like this. Dr. Thomas Hemmerling and his team of McGill's Department of Anesthesia achieved a world first on August 30, 2010, when they treated patients undergoing thyroid gland surgery in Italy remotely from Montreal. The approach is part of new technological advancements, known as 'Teleanesthesia', and it involves a team of engineers, researchers and anesthesiologists who will ultimately apply the drugs intravenously which are then controlled remotely through an automated system.'"

Comments

Hmm

[Anonymous Coward]

World's First Transcontinental Anesthesia

When I read that title and saw that picture, I thought they were talking about a service where an anesthesia team puts someone to sleep for a 14 hour transcontinental flight. Anyone else?

does this mean doctors can be outsourced?

[AvitarX]

That's gonna suck for them, but drop medical costs for me...

Encrypted and validated data stream?

[alphax45]

Is there end to end encryption for this? What if a bit gets dropped? Is there a CRC above and beyond the standard CRC already done? Not sure I trust this...

Re:Encrypted and validated data stream?

[berzerke]

...Not sure I trust this...

Really sure I don't trust this. It's bad enough with all the mistakes doctors make now. Now add to it the possibility of service interruption (cut cables, DOS attacks). Then add what could happen if the computers involved become infected with malware. If the systems were isolated, then *maybe* they could be trusted, but in this case, they are not. Then factor in whether or not the doctor is licensed to operate in a particular country...

So you get around this by having a competent team standing by to take over. But in that case, there's very little potential benefit.

Re:Encrypted and validated data stream?

[Chowderbags]

Dunno about complete automation. Each patient is different, and it's a bit tougher than saying "pulse under 20, bad" or "O2 saturation under 90%, no more gas"(if you're getting operated on due to problems leading to hypoxemia, you want a way to override the settings) (I am neither a doctor nor an anesthesiologist, but I imagine that there's situations like that that aren't extremely rare).

Maybe something more akin to autopilot, which is fine for most of the flight, but you still want a pilot there to deal with the trouble scenarios.

Re:Encrypted and validated data stream?

[Kilrah_il]

Disclaimer: I am a doctor, Jim, not a ****.

A few problems:
1) The technical act of anesthetizing a patient involves, amongst other things, putting a tube inside the patients trachea (AKA intubation) so he can be artificially ventilated - a task that demands a qualified human being. A robot can't do it. Even if you could develop a robot to do it, you would want someone near at hand in cases of difficult intubations.
2) Some operations need more than just a regular IV (intravenous) line and intubation. Sometimes you need a central venous line, arterial line, urine catheter, gastric tube, etc. I don't know how it is in the US, but in Israel most, if not all, of these procedures are performed by the anesthesiologist.
3) In 95% of the cases the anesthesia is going smoothly throughout the operation and the anesthesiologist can sit back and relax (and try not to fall asleep). However, in some of the cases things go wrong. Some of them are easy to fix (blood pressure too low/high - give medication X/Y). But some are harder. For example, in one operation I was in, the patient's O2 saturation went plumbing down. What was the problem? The tubing from the intubation tube to the ventilation machine got disconnected along the way. The anesthesiologist is the one who needs to solve problems such as this. Even for the easy problems, when they happen you want a speedy response. If something happens to the connection at the critical time (and statistics assure you that once in a while something bad will happen at the worst possible moment), the patient could suffer. Gives a whole new meaning to "Denial-of-service" attack.
4) Even if nothing goes wrong, some operations (esp. in the head and neck region) need the anesthesiologist's help during the surgery.
5) The waking up part of the operation also needs an anesthesiologist in the room to carry out some procedures (e.g. extubating the patient, suctioning his airways, making sure he is breathing OK, re-intubating if he can't breath well).

So, while I am all in favor of automation, robots and remote control, I for one see plenty of downsides, but no upside. If anyone has an idea how this can help the patient, I would be glad to start thinking about the cost/benefit ratio. Right now, for me, the ratio is approaching infinite.

Re:Encrypted and validated data stream?

[Kilrah_il]

Oh, and one more things: For many tasks there is still no better tool than a doctor's assessment. One of those tasks is assessing if a patient is properly anesthetized. There has been no success in developing a tool (including EEG) that can give better results than a doctor's opinion.

Re:Encrypted and validated data stream?

[nospam007]

"A robot can't do it."

Lots of doctors can't either. From Wikipedia: ....
However, tracheal intubation requires a great deal of clinical experience to master[208] and serious complications may result even when properly performed.[209] When performed improperly, the associated complications (e.g., unrecognized esophageal intubation) may be rapidly fatal.[210] Without adequate training and experience, the incidence of such complications is unacceptably high.[158] For example, among paramedics in several United States urban communities, unrecognized esophageal or hypopharyngeal intubation has been reported to be 6%[211][212] to 25%.[210] Among providers at the basic emergency medical technician (EMT-B) level, reported success rates for tracheal intubation are as low as 51%.[213] In one study, nearly half of patients with misplaced tracheal tubes died in the emergency room.....

Bad idea

[dkleinsc]

For one very simple reason: network outage. If the anesthesiologist is present, s/he can react if something goes wrong. If they aren't, the patient may well be SOL.

Let's hope they are not running Windows

[Zalgon 26 McGee]

A whole new meaning to "Blue Screen of Death".

Outsourcing Potential

[EmagGeek]

This is truly a breakthrough, but not one with which I am particularly thrilled. I am definitely not comfortable with my life being in the hands of a doctor half way around the world with only a small view of what is going on, and one that depends entirely on network availability.

Also, if something goes wrong that is beyond the scope of what the robot is capable of, how am I guaranteed a competent doctor will be right there locally ready to step in and take over?

While this might be a big TECHNOLOGICAL advancement, I can't really see how this is a MEDICAL advancement or a viable cost-saving measure for health care.

Re:Outsourcing Potential

[Superdarion]

Well, my guess is that the idea is in the lines of schools via videoconference. I don't know about other parts of the world, but here in Mexico there are a lot of schools in faraway small communities, well outside the bulk of civilization, that have no teachers, just tv screens. There is one teacher in a major city broadcasting his/her class so that these schools can learn. There's a whole system with details that are unknown to me, but the system is there.

So why use a doctor that's not physically there but on a videoconference? That's simple; if you need an emergency surgery and live in a remote island with only one doctor and a few nurses, this system might save your life.

Re:Big deal

[Rip Dick]

With some things, you just *need* to be in the same room...

It's been done before in acadamia

[Winckle]

My university has loads of remote learning resources that have a similar effect!

Re:Big deal

[Miseph]

In all honesty, I see and hear a lot about sex toys, particularly off-kilter ones (hazard of the side gigs), and teledildonics is progressing pretty rapidly. They actually have working, commercially available models with bilateral controls... 10 years ago the idea was just a bad joke.

The more you know, the more you sometimes wish you didn't.

Intercontinental

[Doc Ruby]

"Transcontinental" means "across the (same) continent".

"Intercontinental" means "across (or between) multiple continents".

The Internet is a network of networks. The Transnet is nothing.

Why in Idle?

[treeves]

Some Slashdot stories clearly belong in Idle and are not there. This is clearly the opposite case. It's not about entertainment or something funny and it's definitely technology related. Anyway, I'd like to know what my brother-in-law has to say about this. He's an anesthesiologist who has a home on the west coast [of the US] but works at a hospital in the midwest, so I'm sure he has an opinion about it!

Not sure we're there yet

[Sevorus]

Well, as a practicing anesthesiologist at a major academic center on the West Coast, I'd call this interesting but not medically practical at the moment. As a technological breakthrough, it's not really all that novel. So they transmitted vital signs around the world along with a video feed? Okay...but how is that any different from a teleconference?

The problem with "teleanesthesia", as I see it, is that medical knowledge is only a part of what my presence in the OR provides. The ability to physically intervene is something that can't be done by telepresence (not yet, anyway). If the endotracheal tube comes out during surgery, then you're relying on a technician to replace it. If you need a central line (big IV access in the neck or groin), you need a technician or the surgeon to place it. The hundreds of little things like that are what keep an anesthesia care provider with patients in the OR for the entirWell, as a practicing anesthesiologist at a major academic center on the West Coast, I'd call this interesting but not medically practical at the moment. As a technological breakthrough, it's not really all that novel. So they transmitted vital signs around the world along with a video feed? Okay...but how is that any different from a teleconference?

The problem with "teleanesthesia", as I see it, is that medical knowledge is only a part of what my presence in the OR provides. The ability to physically intervene is something that can't be done by telepresence (not yet, anyway). If the endotracheal tube comes out during surgery, then you're relying on a technician to replace it. If you need a central line (big IV access in the neck or groin), you need a technician or the surgeon to place it. The hundreds of little things like that are what keep an anesthesia care provider with patients in the OR for the entire duration of each and every surgery that goes on.

The other issue as I see it is that monitoring the vitals is important, but there are a lot of things that happen in an operating room that you can't monitor as well over a video feed. How much blood is really being lost? Can I visually sweep the floor, the surgical drapes, and the suction canisters easily and get an estimate? A patient can lose a third to half of their blood volume in some cases before you're going to see that reflected in vital signs, by which time you're way behind.

I suppose there is a place for this kind of thing in battlefield medicine and maybe remote third-world locations, but in those cases the anesthesiologist should be considered a consultant to the people on the ground and not "the primary provider", as it were. In order to make this real-world applicable, you'd need a robot on the far end with visual, audio, and tactile feedback, the ability to move around the room, etc - really a surrogate you that you could reliably control as well as your own hands and eyes. Of course, then you've got the issues with dropped connections, security of the feed, etc. What happens when a script-kiddie hacks your anesthesiabot-3000 and goes nuts with the drug delivery system?

Don't get me wrong, like everyone else I'd love to do my job sitting on my couch in my undies via video feed to the "office", but I'm not really sure this much more than a bit of a publicity stunt at this point.e duration of each and every surgery that goes on.

The other issue as I see it is that monitoring the vitals is important, but there are a lot of things that happen in an operating room that you can't monitor as well over a video feed. How much blood is really being lost? Can I visually sweep the floor, the surgical drapes, and the suction canisters easily and get an estimate? A patient can lose a third to half of their blood volume in some cases before you're going to see that reflected in vital signs, by which time you're way behind.

I suppose there is a place for this kind of thing in battlefield medicine and maybe remote third-world locations, but in those cases the anesthesiologist should be con

A similar story

[lsatenstein]

I heard about a Montreal Hospital exchanging digital xrays with an Austrialian hospital. When radiologists are asleep in one country, they are awake in the other, and as long as volumes of xrays are within reasonable limits, the radiologists are not overburdened. Most new Xrays are digitalized, so film xrays as we know it is passé, except for dentists, and here too, it is moving to digital.